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The Effect of Aromatherapy Massage Using Lavender Oil on the Level of Pain and Anxiety During Labour Among Primigravida Women

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Abstract

Background: Labour pain is considered as one of the most intense forms of pain. Psychological challenge such as anxiety can contribute towards women’s perception of pain and may also affect their labor and birth experience. There are modern many non-invasive methods to relieve pain during childbirth. Among these methods is aromatherapy which is the most popular complementary therapy during child birth. Therefore this study aimed to assess the effect of aromatherapy massage using lavender oil on the level of pain and anxiety during labor among primigravida women. Setting: the study was conducted in the labour department at El-Shatby Maternity University Hospital in Alexandria, Egypt. A purposive sample of 60 pregnant women participated in the study. There were randomly assigned to two groups: The first group (n= 30) received aromatherapy back massage with 2 drops of lavender oil dissolved in 50cc almond oil and the second group (n = 30) received only back massage. Four tools were used to collect the necessary data: An Interviewing Assessment Sheet, Partograph, Visual analogue pain intensity scale (VAS) and Spielberger state-trait anxiety questionnaire. Results of the current study illustrated that the mean pain score before intervention was (7.0) for aromatherapy group and (8.1) for control group. Then after intervention, the mean pain score decreased to 6.4 during active phase for aromatherapy group compared to 8.9 for control group. Also, the mean pain score decreased to 7.7 during transitional phase for aromatherapy group compared to 9.6 for control group. There is a statistical significant difference between the two groups after the intervention. Moreover, the mean anxiety score before intervention was (55.47 and 50.40) respectively among the aromatherapy and control group. However, it decreased during the active and transitional phase to (38.40, 36.63) respectively among aromatherapy group compared to (45.13, 44.07) respectively among control group. The difference was statistically significant. The present study concluded that aromatherapy massage with lavender oil can reduce pain and anxiety during labour. Also, it is an effective way to decrease labor duration. It was recommended that lavender aromatherapy massage can be offered to women in labour for pain relief.
American Journal of Nursing Science
2016; 5(2): 37-44
Published online March 2, 2016 (http://www.sciencepublishinggroup.com/j/ajns)
doi: 10.11648/j.ajns.20160502.11
ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online)
The Effect of Aromatherapy Massage Using Lavender Oil
on the Level of Pain and Anxiety During Labour Among
Primigravida Women
Sahar Mansour Lamadah
1
, Ibtesam Nomani
2
1
Obstetric and Gynaecological Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
2
Obstetric and Gynaecological Medicine, Umm Al Qura University, Makkah Al- Mukarramah, KSA
Email address:
dr.saharlamadah@yahoo.com (S. M. Lamadah)
To cite this article:
Sahar Mansour Lamadah, Ibtesam Nomani. The Effect of Aromatherapy Massage Using Lavender Oil on the Level of Pain and Anxiety
During Labour Among Primigravida Women. American Journal of Nursing Science. Vol. 5, No. 2, 2016, pp. 37-44.
doi: 10.11648/j.ajns.20160502.11
Abstract:
Background: Labour pain is considered as one of the most intense forms of pain. Psychological challenge such as
anxiety can contribute towards women’s perception of pain and may also affect their labor and birth experience. There are
modern many non-invasive methods to relieve pain during childbirth. Among these methods is aromatherapy which is the most
popular complementary therapy during child birth. Therefore this study aimed to assess the effect of aromatherapy massage
using lavender oil on the level of pain and anxiety during labor among primigravida women. Setting: the study was conducted
in the labour department at El-Shatby Maternity University Hospital in Alexandria, Egypt. A purposive sample of 60 pregnant
women participated in the study. There were randomly assigned to two groups: The first group (n= 30) received aromatherapy
back massage with 2 drops of lavender oil dissolved in 50cc almond oil and the second group (n = 30) received only back
massage. Four tools were used to collect the necessary data: An Interviewing Assessment Sheet, Partograph, Visual analogue
pain intensity scale (VAS) and Spielberger state-trait anxiety questionnaire. Results of the current study illustrated that the
mean pain score before intervention was (7.0) for aromatherapy group and (8.1) for control group. Then after intervention, the
mean pain score decreased to 6.4 during active phase for aromatherapy group compared to 8.9 for control group. Also, the
mean pain score decreased to 7.7 during transitional phase for aromatherapy group compared to 9.6 for control group. There is
a statistical significant difference between the two groups after the intervention. Moreover, the mean anxiety score before
intervention was (55.47 and 50.40) respectively among the aromatherapy and control group. However, it decreased during the
active and transitional phase to (38.40, 36.63) respectively among aromatherapy group compared to (45.13, 44.07) respectively
among control group. The difference was statistically significant. The present study concluded that aromatherapy massage with
lavender oil can reduce pain and anxiety during labour. Also, it is an effective way to decrease labor duration. It was
recommended that lavender aromatherapy massage can be offered to women in labour for pain relief.
Keywords:
Aromatherapy Massage, Lavender Oil, Labour Pain, Anxiety
1. Introduction
Child birth is a painful and stressful event in a woman's
life. Pregnant women commonly worry about pain during
labour and birth. [1] Labour pain is caused by uterine
contractions, cervical dilatation, vaginal and pelvic floor
stretching. It has been described as one of the most intense
forms of pain. [2, 3] During labour, conflicting emotions are
present; fear and unease that can be coupled with anticipation
and gladness. Anxiety and fear are factors contributing
towards women’s perception of pain and may also affect their
labour and birth experience. [4] The fear of pain during
childbirth is one of the major reasons that make women
prefer Caesarean section. In a study result reported in Iran,
37.2% of women opted for caesarean section due to anxiety
and fear of the labour pain [5].
Also, if the labour pain is not under control, mothers can
face certain risks like feeling of fear, anxiety, helplessness,
and loss of control throughout the birthing process [6].
Labour pain and loss of control are the two most frequently
cited unpleasant experiences of childbirth that may directly
affect woman’s satisfaction about childbirth. [7]
38 Sahar Mansour Lamadah and Ibtesam Nomani: The Effect of Aromatherapy Massage Using Lavender Oil on the Level of
Pain and Anxiety During Labour Among Primigravida Women
In addition, anxiety is the most common psychological
response of women to labor. In fact, 80% of women in labor
have anxiety. According to the control theory, there is a
relationship between pain and psychological problems like
anxiety. [8, 9] Women with lower levels of anxiety have less
pain during labour. In other words, in the presence of anxiety,
severe spasm of the pelvic floor and perineal muscles can
lead to increase in labour pain. [10]
It is also reported that prolonged labor can increase the
risk of complications to mothers, including perineal
laceration, postpartum hemorrhage, childbirth infection and
cesarean section. Also, it may cause offspring hypoxia and
complications. [11, 12]
The nursing management of labour pain is a major goal of
intrapartum care. There are many modern non-invasive
methods to relieve pain during childbirth. Among these
methods is aromatherapy. The use of aromatherapy in
nursing care continues to be popular in many settings. Most
of the nursing literature relates to the use of essential oils in
low doses for massage or use of the oils as environmental
fragrances. At the physiological level, this intervention
increases endorphins, stimulates nerves which decreases
pain, increases circulation and improves blood flow and
oxygenation of tissues. [13, 14, 15]
Aromatherapy is "the science of using highly concentrated
essential oils or essences distilled from plants in order to
utilize their therapeutic properties.” The oils may be
massaged into the skin, or inhaled by using a steam infusion.
The most common application of aromatherapy during labor
is by massage, bath or inhalation. [16, 17]
However, lavender oil is commonly used in aromatherapy.
Lavender oil is a fabulous multi-purpose essential oil.
Because of its analgesic properties it can be used to alleviate
pain in different conditions such as changing dressings,
palliative care, controlling labor pain as well as chronic pain.
The linalyl acetate component of lavender can relax smooth
muscles. [18]
Lavender essential oil also has a wonderful calming effect.
Inhaling lavender aroma diminishes the secretion of cortisol
from the adrenal gland and produces relaxation through
inhibiting sympathetic activity and stimulating the
parasympathetic system. [19] There are no studies or
published evidences that demonstrate harm from essential
oils to mother or fetus. [20]
When aroma massage is applied over the skin and enters
into the bloodstream through the skin pores, it provides a
sense of wellbeing and it reduces the need for invasive
methods of pain relief. [21] It was reported in a study that
aromatherapy helps to relieve pain, anxiety, depression,
fatigue and creates confidence and creativity. [22]
1.1. Significance of the Study
Childbirth is one of the most painful experiences and the
most significant physical challenge for women to undergo
during their lives. [23] During delivery, excessive pain leads
to fear and anxiety which will lead to increased blood levels
of hormones such as epinephrine. These will further intensify
the pain, and potentially prolong the first and second stages
of labor, thus resulting in a very unpleasant experience of
childbirth. Also, anxiety and stress during labour may
decrease the amplitude and frequency of uterine contractions
and thus, increase the labour duration and the likelihood of
assisted delivery and even Cesarean section. Moreover, more
bleeding during labor and delayed onset of lactation have
been observed among anxious women. [24] So, the use of
fragrant essential oil like lavender in massage during labour
helps to create a state of calmness, alleviate anxiety and
reduce pain. Aromatherapy massage is one of the most
popular tools that nurses can use to enhance their nursing
care and simultaneously empower themselves. [25] As a
non-pharmacological intervention, it is easy to administer,
cost effective, harmless, do not require much training, and
appealing to the mother. This intervention may be used by
nurses as a part of their routine when providing care to
women during labour. [26] So, this study provides direction
to introduce aromatherapy massage in nursing practice by
testing its efficacy on relieving labour pain and anxiety.
1.2. Aim of the Study
The aim of this study was to assess the effect of
aromatherapy massage using lavender oil on the level of pain
and anxiety during labor among primigravida women.
1.3. Research Hypotheses
1. Women who receive aromatherapy back massage with
lavender oil during active and transitional phases of
first stage of labour experience lower level of labour
pain than those who do not receive such an
intervention.
2. Women who receive aromatherapy back massage with
lavender oil during active and transitional phases of
first stage of labour experience lower anxiety level than
those who do not receive such an intervention.
2. Subjects and Method
2.1. Study Design and Setting
A randomized control clinical trial was used in this study.
The study was conducted in the labour department at El-
Shatby Maternity University Hospital in Alexandria, Egypt.
2.2. Subjects
A purposive sample of 60 pregnant women were selected
according to the following.
2.2.1. Inclusion Criteria
Primigravida.
18-35 years old, had term, singleton pregnancy.
Cephalic presentation.
Did not take analgesic drugs in the past eight hours.
Did not receive any non-pharmacological methods of
pain relief in the past eight hours.
American Journal of Nursing Science 2016; 5(2): 37-44 39
Did not have any medical and pregnancy
complications.
Normal uterine contractions.
3-4 cm cervical dilation.
2.2.2. Exclusion Criteria
Allergy to oil
After explanation and obtaining oral consent from the
women, they were randomly assigned to two groups: The
first group (n= 30) received aromatherapy back massage with
2 drops of lavender oil dissolved in 50cc almond oil and the
second group (n = 30) received massage only.
2.3. Tools of Data Collection
Four tools were developed and used to collect the
necessary data:
Tool I: An Interviewing Assessment Sheet
It was developed by the researcher and includes the
following:
Socio-demographic characteristics such as age, level of
education, occupation and residence.
History of present pregnancy and labour.
Women's satisfaction regarding massage.
Tool II: Partograph [27]:
It is a standardized design done by WHO (1994) to help in
the management of labor. This Partograph is basically a
graphic representation of the event of labor plotted against
time. Uterine contractions (intensity, duration and frequency
in 10 minutes) and maternal vital signs are also assessed.
Durations of the three stages of labor were explained as
follows (First stage: When the cervix was about 4 cm dilated
till 10 cm, second stage: From 10 cm cervical dilatation to
the delivery of baby, third stage: from the delivery of the
baby to the delivery of placenta. The fetus is also monitored
closely on the Partograph by regular observation of the fetal
heart rate and color of liquor.
Tool III. Visual analogue pain intensity scale (VAS) [28]:
The pain VAS is a unidimensional measure of pain
intensity. It is used to assess pain intensity: which represents
pain along a continuum of 2 extremes, from no pain (a score
of 0) to extreme pain (a score of 10). The pain scores were
recorded before intervention at latent phase and after
intervention at 5-7 cm and 8-10 cm cervical dilation. The
pain VAS is self-completed by the women. The women were
asked to place a line perpendicular to the VAS line at the
point that represented their pain intensity. Pain score from 1-
3 was considered mild pain, from 4-6 was considered
moderate pain and from 7-10 was considered severe pain.
Tool IV: Spielberger state-trait anxiety questionnaire [29]:
It includes 20 items of the mentioned anxiety
questionnaire. Since each item was scored as 1-4. The total
anxiety score ranged between 20 and 80: (20-40) mild
anxiety, (41-60) moderate anxiety and (61-80) severe anxiety.
This questionnaire is widely used to measure state-trait
anxiety in clinical studies and has a correlation coefficient of
0.85-0.91. [30] The anxiety levels were recorded before
intervention and after intervention at 5-7 cm and 8-10 cm
cervical dilation.
2.4. Validity and Reliability
Tool I was submitted to five academic nursing experts in
the field to test the content validity of it. Modifications were
carried out according to the academic nursing experts'
judgment on clarity of sentences and the appropriateness of
the content. Tool reliability was tested using Alpha Cronbach
test. Its result was 0.80 which indicates an accepted
reliability of the tool.
2.5. Administrative Design
Approval was obtained from the ethical committee of the
Faculty of Nursing- Alexandria.
University and the responsible authorities of the study
setting.
2.6. Pilot Study
The study tools were pre-tested on a random sample of 6
women (10%) selected from the same study setting to check
the clarity, applicability, any difficulties with their
application, and to determine the time needed for completion
of the tools. Modification of the tools was done according to
the pilot study results. Subjects who shared in the pilot study
were excluded from the study subjects.
2.7. Procedure
The study was achieved through three phases namely
assessment, implementation and evaluation.
2.7.1. Assessment Phase
The aim of this phase was to collect data about women to
determine those who have the inclusion criteria using tool I
&II. Then, they were individually interviewed by the
researcher to complete the basic data using an Interviewing
Assessment Sheet (tool I).
2.7.2. Implementation Phase
After explanation of the procedure and obtaining oral
consent of women, women were randomly assigned to
aromatherapy and control groups.
One group (n=30) received aromatherapy back massage
with 2 drops of Lavender oil dissolved in 50 cc almond
oil as a carrier oil, the second group (n=30) received
back massage only without oil.
The massage was given to all women in lateral position
by the researchers. Back massage was done gently with
medium pushing and rhythmic mode in the active phase
(cervix dilated 5-7 cm) and transitional phase (8 - 10
cm) of labour for 20 minutes every time.
2.7.3. Evaluation Phase
Then women were asked to self-rate their level of pain
before intervention at latent phase and after
intervention at active (5 -7 cm cervical dilatation) and
transitional phase (8-10 cm cervical dilatation) using
the pain visual analogue scale (tool III).
40 Sahar Mansour Lamadah and Ibtesam Nomani: The Effect of Aromatherapy Massage Using Lavender Oil on the Level of
Pain and Anxiety During Labour Among Primigravida Women
Intensity of anxiety in both groups was measured before
intervention at latent phase and after the intervention at
dilations of 5 -7 cm and 8-10 cm using the Spielberger
state-trait anxiety questionnaire (tool IV).
The women were followed during the labour process by
using Partograph (tool II).
2.8. Ethical Consideration
Before the beginning of the study, an informed oral
consent was taken from the women after explaining the aim
of the study and its phases. The participants were assured of
the confidentiality of their personal information. Women
were allowed to withdraw from the study at any time. The
data was collected over a period of 3 months from the
beginning of June to the end of August 2015.
2.9. Statistical Analysis
Data was collected, coded, tabulated and analyzed, by
using the SPSS 18.0 statistical software package. Descriptive
statistics was used to calculate percentages and frequencies,
(t) test was used to estimate the statistical significant
differences between variables. A significant P-value was
considered when it is less than 0.05 and it was considered
highly significant when P value is less than or equal 0.01.
3. Results
As shown in table (1), the age of one third of women in
aromatherapy group (33.3%) was between 25- < 30 years old
compared to 23.3% of control group. In addition, one third of
women in each group (33.3%, 33.3 %) had received
university education. More than three quarters of women in
control group (83.3%) were housewives compared to 70.0%
of women in aromatherapy group. Most of the women in
aromatherapy and control group (93.3%, 90.0%) respectively
lived in urban area.
Table (2) illustrates the mean pain scores before and after
intervention among aromatherapy and control group. The mean
pain score before intervention was (7.0) for aromatherapy group
and (8.1) for control group and there is no statistical significant
difference between them. Then after intervention, the mean pain
score decreased to (6.4) at 5-7 cm and (7.7) at 8-10 cm cervical
dilatation for aromatherapy group compared to (8.9) at 5-7 cm
and (9.6) at 8-10 cm cervical dilatation for control group. There
is a highly statistical significant difference between the two
groups (P<0.01).
As shown in table (3), the mean anxiety score was high
among the aromatherapy and control group (55.47 and 50.40)
respectively before intervention and there is no statistical
significant difference between them. However, the mean
anxiety score at cervical dilation of 5-7 cm was 38.40 in
aromatherapy group compared to 45.13 in control group. The
difference was statistically significant (P = 0.050). In
addition, the mean anxiety score was 36.63 in aromatherapy
group at 8-10 cm cervical dilatation compared to 44.07
among control group. The difference was statistically
significant (P<0.05).
As shown in table (4), the mean duration of first stage was
2.73 hours for aromatherapy group and 3.17 hours for control
group. A statistically significant difference was found (P <
0.05). During second stage of labour, the mean duration was
23.60 minutes for aromatherapy group compared to 27.23
minutes for control group and a highly statistical significant
difference was found (P < 0.01). Finally during the third
stage, the mean duration was 11.46 minutes for aromatherapy
group and 24.93 minutes for control group and a highly
statistical significant difference was found (P < 0.01).
Figure (1) reveals women's satisfaction regarding massage
during labour among the aromatherapy and control group. It
can be observed that, most of the women (82.0%) in the
aromatherapy group were satisfied compared to 69.4 % of
women in the control group. Moreover, a minority of women
from aromatherapy and control group (3.7 %, 10.0%)
respectively were dissatisfied.
As shown in figure (2), all the aromatherapy group (100%)
had normal vaginal delivery compared to 96.4% from control
group.
Table 1. Distribution of the study subjects according to their socio-demographic characteristics (n = 60).
Items Aromatherapy group Control group
n = 30
% n=30 %
Delete this empty raw
Age
< 20 2 6.7 8 26.7
20 - < 25
10 33.3 6 20.0
25- < 30
10 33.3 7 23.3
30 - 35 8 26.7 9 30.0
Educational level
Read and write 5 16.7 4 13.3
Primary
5 16.7 7 23.3
Secondary
10 33.3 9 30.0
University 10 33.3 10 33.3
Occupation:
House wife 21 70.0 25 83.3
Work
9 30.0 5 16.7
American Journal of Nursing Science 2016; 5(2): 37-44 41
Items Aromatherapy group Control group
n = 30
% n=30 %
Delete this empty raw
Residence
Urban 28 93.3 27 90.0
Rural
2 6.7 3 10.0
Total
30 100.0 30 100.0
Table 2. Mean pain scores before and after intervention among aromatherapy and control group.
Dilatation stage Aromatherapy group Control group t p
Mean SD Mean SD
Before intervention (Latent phase) 7.0 .11
8.1 .14 4.9 0.08
5-7 cm dilatation (Active phase) 6.4 .20
8.9 .19 16.5 0.002
8-10 cm dilatation (Transitional phase) 7.7 .17 9.6 .50 20.1 0.000
Table 3. Mean anxiety scores before and after intervention among aromatherapy and control group.
Dilatation stage Aromatherapy group Control group t P
Mean SD Mean SD
Before intervention (Latent phase) 55.47 9.91 50.40 5.75 3.04
0.07
5-7 cm dilatation (Active phase) 38.40 6.53 45.13 9.10 8.04 0.05
8-10 cm dilatation (Transitional phase) 36.63 8.05 44.07 9.95 14.9 0.03
Table 4. Mean duration of labor stages among aromatherapy and control group.
Labour stage Aromatherapy group Control group t p
Mean SD Mean SD
Duration of first stage (Hours) 2.73
1.05 3.17 1.23 12.6
0.04
Duration of second stage (Minutes) 23.60
15.35 27.23
2.21 17.9
0.006
Duration of third stage (Minutes) 11.46 2.31 24.93 8.37 7.8
1
0.005
Figure (1). Women's satisfaction regarding massage during labour among aromatherapy and control group. (please put it under the figure directly)
42 Sahar Mansour Lamadah and Ibtesam Nomani: The Effect of Aromatherapy Massage Using Lavender Oil on the Level of
Pain and Anxiety During Labour Among Primigravida Women
Figure (2). Types of delivery among aromatherapy and control group.
4. Discussion
When a woman faces the childbirth process for the first
time, she often feels anxiety because coping with labour pain
is usually viewed as an anxious moment. Labour pain is
considered the most unpleasant aspect of labour experience.
Labour pain is progressive, with rapid alterations of its
location and an increase in severity with advancing dilatation
and intensity of uterine contractions. [31, 32] Aromatherapy
is one of the non-pharmacological methods for pain relief
and Lavender oil is a mild sedative and antispasmodic. Also,
the essential oil derived from lavender is used in
aromatherapy to treat anxiety. [33] The study achieved its
hypotheses in demonstrating that lavender aromatherapy
massage is effective in relieving labour pain and anxiety.
The results of the current study showed a reduction in the
mean pain score among the aromatherapy group compared to
the control group and the difference is statistically significant.
This means the effectiveness of lavender oil in labour pain
reduction which may be due to the sedating effects of linalool
acetate in lavender as a narcotic. [34] These results are in line
with the results of Janula R and Mahipal S (2015) who
reported the effectiveness of aromatherapy massage in
reducing labor pain during all labour stages. [21] Also, the
results of Zahra A and Leila M (2012) revealed that lavender
oil massage was effective method in decreasing pain during
labor at cervical dilatation of 4-5cm, 6-7cm and 8-10 cm. [33]
In addition, Chang et al (2002) had a study in which
aromatherapy massage is effective intervention for labor pain
reduction. [35] Burns et al. (2000) also confirmed that
aromatherapy is useful way to relieve pain and strengthen the
uterine contractions during labor. [34]
A randomized control trial was done in India to assess the
effect of aromatherapy massage on labour pain intensity,
there were no maternal adverse effects and the study
achieved its main objective that, lavender aromatherapy
massage was effective in relieving labour pain and its
intensity and reducing duration of labour in experimental
group whereas in massage only group, there was not a
reduction in pain intensity and duration of labour. [26]
However, the results of the current study are contradicted
with the results of a systematic review by Smith et al. (2011)
on 535 women in comparing aromatherapy with placebo for
pain management of labor, there was no difference between
groups for the pain intensity and the length of labor. The
authors, however, concluded that further research is needed
before final recommendations. [36]
The mean anxiety scores among the two groups in the
present study showed that Lavender aromatherapy massage
could reduce anxiety during labor.
These results are
congruent with the results of Namazi M et al (2014) who
found that the levels of anxiety at dilatations of 3-4 and 6-8
cm were significantly lower in the aromatherapy group
compared with the control group
.
[37] Also, Hee rho et al.
(2009) who investigated the effects of aromatherapy massage
on the anxiety and self-esteem experienced by elderly
Korean women found that, there was a significant difference
in the anxiety and self-esteem among the two groups. [38]
Imanishi J et al. (2009) reported that anxiety scores
significantly decreased after each aromatherapy massage
session. [39] According to Smith et al (2011) and Bastard et
al (2006), essential oils improved mood and reduced anxiety
during labor by stimulating the olfactory pathways in the
limbic system. [36, 40]
Moreover, the results of current study are in accordance
with the results of a study carried out by Osaka et al (2009)
about the administration of a hand massage. Despite the short
duration of only five minutes, a statistically significant
reduction of the perception of anxiety could be achieved
from massage only. [41] Furthermore, Bastered et al (2009)
had a study which confirmed that aromatherapy massage
have successfully been used to produce significantly greater
improvement in reduction of anxiety during labour. [42]
Also, Susan Mousley et al (2005) had a study in which
aromatherapy massage is aiding relaxation and reducing
anxiety during labour. [43] Similarly Jennings and Wilkinson
(2004) reported that lavender oil promotes relaxation, and it
may give soothing effect to the skin and stimulate the nerve
endings when applied like a massage. [15]
Prolonged duration of first stage of labour is an important
cause of Caesarean and instrumental vaginal delivery. If
duration of labour is prolonged, it may cause offspring
hypoxia. [26] The results of the present study reveal that the
mean length of labour duration also reduced in the first,
second and third stages of labour among aromatherapy group
compared to control group and the difference was
statistically significant. These results are congruent with the
results of Raju and Signh (2014) who found significant
difference between aromatherapy and biofeedback group
regarding labour duration. [26]
Aromatherapy is an effective, non-pharmacological pain
relief method. The present study showed that most of the
women in the aromatherapy group were satisfied with the
aroma massage. These results are in line with results of Raju
and Signh (2014) and Chang et al (2002) who mentioned that
the majority of women reported satisfaction about their
labour experience. [26, 35]
American Journal of Nursing Science 2016; 5(2): 37-44 43
5. Conclusion and Recommendations
5.1. Conclusion
From the results of the current study, it can be concluded
that aromatherapy massage with lavender oil can reduce
labour pain and anxiety during labour. Also, it is an effective
way to decrease labor duration. Most of the women were
satisfied by this intervention. This method can influence the
quality of care provided during childbirth by reducing the
suffering of women in labour.
5.2. Recommendations
Based on the findings of the present study, the following
recommendations are suggested:
1. Aromatherapy massage using lavender oil can be
offered to women in labour who want to avoid
pharmacological methods for pain relief.
2. Further studies are required to investigate the effects of
aromatherapy massage on neonatal outcomes.
3. A comparative study can also be done between the
effectiveness of various non-pharmacological measures
for labour pain.
4. Provide an educational program for nurses about
aromatherapy.
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... The required sample was determined with the independent t-test using G* power software free 42 with an estimated effect size of 0.65 as the reduction in anxiety scores measured via the Spielberger State-trait Anxiety Inventory in the intervention group was compared to the control group. 18,[43][44][45] The total number was 184 with 92 in each group after an adjustment of (20%) for those who gave no response and/or dropped out. However, the sample size was further inflated when the primigravidae encountered, in the early recruitment, and expressed a high preference for pain relief, and thus a higher attrition rate was anticipated, and an increased possibility of participants that can turn into a cesarean section delivery was noted. ...
... This positive impact on lowering the labor pain has also been observed in earlier studies. 43,[55][56][57] Different RCTs utilized massage, acupressure, massage plus acupressure, sacral massage, and Lamaze breathing as interventions and reported significantly lower VAS scores, ranging from (3.57 to 8.83) in the intervention group. 43,[55][56][57] Another study reported lower pain scores in the massage group that applied firm and rhythmic back massages PBI scored (1.73 ± 0.45) compared to the control group (2.17 ± 0.59). ...
... 43,[55][56][57] Different RCTs utilized massage, acupressure, massage plus acupressure, sacral massage, and Lamaze breathing as interventions and reported significantly lower VAS scores, ranging from (3.57 to 8.83) in the intervention group. 43,[55][56][57] Another study reported lower pain scores in the massage group that applied firm and rhythmic back massages PBI scored (1.73 ± 0.45) compared to the control group (2.17 ± 0.59). 48 Studies that applied foot reflexology and Swedish massages during labor reported lower pain scores on the McGill Pain Scale in the intervention group. ...
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Background: Labor pain and anxiety are important concerns during labor, especially among the primigravidae. It may increase the duration of labor, increase stress hormones, and affect maternal and new-born related outcomes. This study examined the effectiveness of combined breathing exercises, foot reflexology, and massage (BRM) interventions on labor pain, anxiety, labor duration, stress hormone levels, maternal satisfaction, maternal vital signs, and the new-born's APGAR scores. Participants and methods: This single-blind-parallel randomized controlled trial (RCT) was conducted at the Maternity and Children Hospital (MCH), Makkah, Saudi Arabia, by recruiting primigravidae aged 20 to 35 years, without any medical complications, and who were block-randomized at six-centimeter cervical dilation and stratified by intramuscular pethidine. The intervention is BRM compared to standard care. The labor pain was measured via present behavioral intensity (PBI) and visual analogue scale (VAS), and the anxiety was measured via Anxiety Assessment Scale for Pregnant Women in Labor (AASPWL). The secondary outcomes were duration of labor, maternal stress hormone levels, maternal vital signs, maternal satisfaction, fetal heart rate, and APGAR scores. All outcomes were measured at multiple time-points during and after contraction at baseline, during BRM intervention, at 60, 120, and 180 minutes post-intervention. Generalized linear mixed models were used to estimate the intervention effects over time. Results: A total of 225 participants were randomized for the control (n = 112) and intervention group (113). BRM lowered the labor pain intensity at 60 minutes after intervention during (1.3 vs 3.5, F = 102.5, p < 0.001) and after contraction (0.4 vs 2.4, F = 63.6, p < 0.001) and also lowered anxiety (2.9 vs 4.2, F = 80.4, p < 0.001). BRM correspondingly lowered adrenocorticotropic (ACTH) (133 vs 209 pg/mL, p < 0.001), cortisol (1231 vs 1360 nmol/mL, p = 0.003), and oxytocin (159 vs 121 pg/mL, p < 0.001). It also shortened the labor duration (165 vs 333 minutes, p < 0.001), improved vital signs, which resulted in higher APGAR scores, and increased maternal satisfaction. Conclusion: The labor unit management could consider adopting BRM as one of the non-pharmacological analgesia for healthy women in labor. Trial registration: ISRCTN87414969, registered 3 May 2019.
... Bagi perempuan yang mengalami rasa cemas yang rendah besar kemungkinan akan mengurangi rasa nyeri yang dialami ketika melahirkan. (Mansour Lamadah, 2016). ...
... 4. Nyeri adalah akibat dari adanya kerusakan jaringan atau akan mengalami kerusakan yang memberikan dampak rasa tidak menyenangkan (Mansour Lamadah, 2016). ...
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Pandemi Covid-19 berdampak pada semua aspek kehidupan. Upaya penerapan protokol kesehatan (prokes) begitu ketat dijalankan. Namun, seiring berjalannya waktu, pelaksanaan prokes mulai melonggar. Tenaga kesehatan merupakan garda terdepan yang tidak pernah berhenti memberikan upaya terbaik untuk memerangi Covid-19. Tanpa kita sadari, mereka juga adalah manusia, yang juga memiliki kekhawatiran akan penularan Covid-19 dari pasien yang mereka tangani. Berangkat dari hal tersebut, para penulis ‒yang merupakan praktisi kebidanan‒ dalam buku ini mencoba untuk berkontribusi sebagai bentuk solidaritas kepada sesama tenaga kesehatan, terkhusus untuk para bidan. Dengan harapan apa yang kami sampaikan melalui buku ini dapat menjadi sumber literasi dan ilmu pengetahuan bagi para bidan dan juga masyarakat luas. Kami juga menyampaikan terima kasih kepada pihak-pihak yang terlibat dalam penyusunan buku ini, sehingga buku ini dapat selesai dan bermanfaat bagi orang banyak. Permohonan maaf pun tak luput kami sampaikan atas kekurangan yang terdapat di dalam buku ini. Semoga buku ini dapat membantu dan meningkatkan pengetahuan para pembacanya.
... İncelenen tez çalışmalarının tamamına yakınında uygulanan aromaterapinin ağrı (12, 13, 17, 18, 20, 22-24, 27, 28), yorgunluk (11,12), anksiyete ve kaygı (18,21,27) düzeyini azalttığı, uyku kalitesini (11,21,27) arttırdığı, bulantı-kusmada etkili olduğu saptanmıştır. Bu sonuçlara paralel olarak literatürde aromaterapi kullanımının ağrı (30)(31)(32), yorgunluk (33) ve anksiyetekaygı (30,31,34) düzeyini azalttığı, uyku kalitesini artırdığı (34,35), bulantı-kusmada azalmayı (36) sağladığı belirtilmektedir. Ayrıca tez çalışmalarının bazılarında aromaterapi uygulamasının bazı yönlerden de etkili olmadığı saptanmıştır. ...
... İncelenen tez çalışmalarının tamamına yakınında uygulanan aromaterapinin ağrı (12, 13, 17, 18, 20, 22-24, 27, 28), yorgunluk (11,12), anksiyete ve kaygı (18,21,27) düzeyini azalttığı, uyku kalitesini (11,21,27) arttırdığı, bulantı-kusmada etkili olduğu saptanmıştır. Bu sonuçlara paralel olarak literatürde aromaterapi kullanımının ağrı (30)(31)(32), yorgunluk (33) ve anksiyetekaygı (30,31,34) düzeyini azalttığı, uyku kalitesini artırdığı (34,35), bulantı-kusmada azalmayı (36) sağladığı belirtilmektedir. Ayrıca tez çalışmalarının bazılarında aromaterapi uygulamasının bazı yönlerden de etkili olmadığı saptanmıştır. ...
... Lamadah (38) Sixty primiparous pregnant subjects with term pregnancy and cephalic presentation (40) only evaluated nulliparous births. One paper delved into all types of births (18). ...
... In trials where aromatherapy was employed in combination with massage, the overall levels of labor pain were considerably lower in the intervention group compared to pre-intervention although no differentiation was detected between the experimental and control groups (22,36). In a study, lavender massage aromatherapy reduced mean labor discomfort in the productive and transitional phases of labor considerably more than the control group (38). In three experiments at varying cervical dilatation stages, the overall mean of labor pain was not statistically different in inhalation aromatherapy via masks in comparison with the controls. ...
Article
Background: Controlling labor pains is now an essential part of midwifery care, and aromatherapy is a well-known medicinal treatment for easing labor pains. The aim of this research was to evaluate and analyze the most recent clinical trial results on the effects of lavender aromatherapy on labor pain management. Methods: Several keywords were searched in the MEDLINE/PubMed, Scopus, and Google Scholar databases, including lavender, Lavandula, childbirth, labor, pregnancy, labor pain, aromatherapy, and delivery. Two authors extracted the data, and the Cochran quality management tool was used to assess the consistency of each study. Results: In general, 7 studies were reviewed after checking the titles and abstracts of the studies and eliminating obsolete or low-quality studies. Two studies were conducted in Egypt and Indonesia, and five studies were conducted in Iran. There were a wide variety of qualities in the studies, which could render more quantitative synthesis impractical. Massage aromatherapy was employed in three trials, and inhalation was applied in four studies. All findings suggested that lavender aromatherapy in both methods could reduce active phase labor pain. Conclusion: Although the results of this study showed that lavender aromatherapy suppressed labor pain, more detailed randomized clinical trials with higher precision are needed to achieve an accurate outcome for data generalization regarding the use of labor pain management.
... The oil is channeled to the part of the organ that requires treatment so that the pain is reduced. [55] stated that at a physiological level, this intervention was able to increase endorphins, stimulate nerves thereby reducing pain, increasing blood flow, and tissue oxygenation. The use of lavender oil which is an analgesic can reduce pain, control labor pain, and lower back pain because it contains a lavender linalyl acetate component which functions to relax smooth muscles [56] . ...
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Pregnant women are a high-risk group because they experience physical and psychological changes, one of which is often complaints of lower back pain (LBP) in the third trimester. This can be due to changes in positioning, walking too often, using high heels, or lifting heavy weights. Effleurage massage is a complementary therapy to reduce LBP. The combination with lavender essential oil aromatherapy may reduce LPB more optimally. The purpose of this study was to identify the impact of a combination of effleurage massage with lavender essential oil aromatherapy on LBP in pregnant women. The research used a quasi-experimental pretest-posttest design with a control group. The sample consisted of 16 third-trimester pregnant women for each group (intervention and control), recruited through the purposive sampling. This research was conducted in the area of the Padangsari Health Center, Semarang City in February-March 2021. The Numerical Rating Scale (NRS) of pain was used. The intervention provided was a combination of effleurage massage with lavender essential oil aromatherapy four times a month for 15-20 minutes per session. Data were analyzed using the Wilcoxon test and independent t test. The results showed that the combination of effleurage massage with lavender essential oil aromatherapy led to a significant decrease in LBP in pregnant women (p < 0.001). This therapy can be carried out by the family as needed because it is easy, does not cause side effects, and basic ingredients are available in the market. Nurses can accompany pregnant women and their families in the non-pharmacological management of LBP integrated with maternal health programs in primary health care facilities. Keywords: aromatherapy lavender essential oil, effleurage massage, lower back pain, pregnant women
Article
Childbirth is one of the most important events in woman’s life. Different methods are typically used for labour augmentation. Aromatherapy is one of the complementary methods. The present systematic review evaluated the efficacy of aromatherapy in reducing the duration of labour. A systematic search of all clinical trials studies on Cochrane, Scopus, Web of Science, PubMed, ProQuest, Google scholar, Irandoc, Science direct, Magiran and Sid was performed up to September 2021. A total of 22 articles met the inclusion criteria and 3234 women used a variety of aromatherapies. Results showed that some aromatherapies, such as lavender was almost effective in reducing length of labour. Results suggest that some aromatherapy can be an effective, inexpensive and holistic method of reducing the duration of labour but it should be used with caution.
Article
Background : This research aimed to reveal the effect of lavender essence inhalation and the massage therapy applied with lavender oil on the severity of labor pain of primiparous women. Methods : This randomized controlled trial was conducted with three groups. Pregnant women participating in the study were randomly divided into control group (n=40), lavender essence inhalation group (n=44) and lavender essence massage (n=37) groups. The applications were divided in three for each phase in the first stage of labor (early, active and transition). Thereafter sacral compression and circular massage were applied for 15 minutes on the lower back (waist) region of the participants by using 2 drops of lavender oil in each phase of labor; 2 drops of lavender oil were dripped onto the palms of the participants in the inhalation group by the researcher and they were asked to inhale it for 3 minutes. Research data were collected using Personal Information Form (PIF), Visual Analogue Scale (VAS) and Postpartum Assessment of Women Survey (PAWS). Results : The results of the research revealed that the labor pain perceived by the women who were applied inhalation and massage therapy using lavender essential oil were milder compared to the control group (p<0.05). Another finding of the research revealed that the lavender oil inhalation gave the best results in the latent phase, however the massage therapy with lavender oil was more effective in the active and transition phases. Conclusion : Inhalation and massage therapy applied using lavender essential oil contributed to the alleviation of perceived labor pain. For this reason, massage therapy and inhalation applications using lavender oil are recommended to be applied by midwives as a complementary method to adapt to labor pain during delivery.
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ÖNSÖZ Tıbbi ve aromatik bitkilerden elde edilen aromatik-kokulu-uçucu yağlar/esans yağlar son yıllarda kozmetik ve insan sağlığını koruma ve geliştirme amacıyla oldukça yaygın kullanım alanı bulmuştur. İnsanlık tarihi kadar eski geçmişi olan esans yağlarının tıp ve eczacılık alanında kullanımı ile ilgili her geçen gün yeni gelişmeler sağlanmaktadır. Ülkemizin farklı üniversiteleri ve/veya özel sektörün seçkin temsilcileri, uzmanlarca hazırlanan “ESANS YAĞLARIN (ARONATİK YAĞLARIN) SAĞLIK ALANINDA KULLANIMI” kitabı, esans yağların Antiparazitik, Antienflamatuar, Antiviral Etkileri incelenerek, Kozmetikte, Tıpta Yetişkin ve Pediatrik Gruplarında, Tıpta Analjezi ve Sedasyon Olarak Kullanımı, Tedavi Amaçlı Kullanımı, Tıp’ta Aromaterapi Olarak Kullanımı, Alternatif Tıpta (Fitoterapi Olarak) Kullanımı, Dezenfektan ve Antiseptik olarak kullanımı, Kadın Doğumda Kullanımı, Diş Hekimliğinde Kullanımı gibi birçok alanı kapsayan multidsipliner bir çalışma olarak karşımıza çıkmaktadır. Tıbbi ve aromatik bitkilerden elde edilen esans yağlarının sağlık alanında kullanımına dair kapsamlı, doyurucu ve güncel literatürü içeren bilgiler içermektedir. Eserin, akademisyenlerin araştırmalarına yardımcı olması yanı sıra, bu alanda araştırma yapmak isteyen öğrencilere ve esans yağlardan sağlık alanında yararlanmak isteyen tüm kesimlere katkı sağlayacağını ümit ediyoruz.
Article
Background Severe pain during the first stage of labour can harm both the mother and fetus. Previous studies have shown that severe pain in childbirth can cause discomfort, stress, risk of depressive disorders, decreased intestinal motility and prolonged labour for the mother. For the fetus, it can cause hypoxia, metabolic acidosis, cognitive and emotional disorders and even death. Therefore, better management of labour pain during the first stage is needed. Aim This study aimed to assess the effect of sensory stimulation to reduce pain in the first stage of labour. Methods Garuda portal, the Perpustakaan Nasional Republik Indonesia e-resource, the Cochrane Central Register of Controlled Trials and Pubmed were used to search for literature. The inclusion criteria were original randomised controlled trials published in English, in 2014–2020, with a minimum sample size of 30 where the study outcome was rated on a pain scale. Results Ten randomised controlled trials were included. The primary interventions using sensory stimulation to reduce pain during the first stage of labour were aromatherapy, music therapy, breathing control, focusing, and virtual reality. Conclusions Sensory stimulation by aromatherapy, music therapy, breathing control, focusing and virtual reality are effective in reducing pain in the first stage of labour.
Article
Aim: Perinatal negative emotions are common in parturient women, but the problems are often ignored. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that investigated the effectiveness of aromatherapy for intrapartum anxiety (IPA) and postpartum emotional symptoms (PES). Methods: We searched PubMed, Embase, Cochrane library, and ClinicalTrials.gov to identify suitable RCTs for analysis, and the study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: Nine RCTs were included. The meta-analysis showed aromatherapy reduced IPA during the early to active phase (standardized mean difference [SMD]: -1.56 [-2.55, -0.61]) and during the transition phase (SMD: -3.30 [-4.97, -1.63]) when compared with controls. For the postpartum period, the meta-analyses showed a reduction of postpartum depression (PPD) at week 2 (SMD: -0.43 [-0.82, -0.03]), and a non-significant trend toward the reduction of PPD at weeks 4-6 (SMD: -0.70 [-1.40, 0.01]). Conclusion: Our study found some evidence supporting the effectiveness of aromatherapy in reducing intrapartum anxiety and PES. We recommend the optional use of aromatherapy for intrapartum and postpartum care.
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The study was conducted to assess the effectiveness of jasmine oil massage on labour pain during first stage of labour among 40 primigravida women. The study design adopted was true experimental approach with pre-test - post-test control group design. The demographic Proforma were collected from the women by interview and Visual analogue scale was used to measure the level of labour pain in both the groups. Data obtained in these areas were analysed by descriptive and inferential statistics. A significant difference was found in the experimental group(tcal 9.869, p<0.05). A significant difference was found between experimental group and control group. cal The pre-test ('tcal' 0.36, p>0.05) and the post-test (tcal 11.75, p<0.05). No significant association was found between the level of labour cal cal pain and demographic variables in the experimental group. In this study Jasmine oil massage proved to reduce first stage labour pain.
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Background: Labour pain is the most severe form of pain that every woman may experience during intranatal life. Severe pain makes stress response which may lead to harmful effects on both mother and her fetus. This study was carried out to evaluate the effect of aromatherapy and biofeedback in promotion of labour outcome during childbirth among primigravidas. Methods: This clinical trial was performed on 600 nulliparous women selected randomly who were expected to have a normal childbirth. Cases were randomly assigned to Aromatherapy group (n=200), biofeedback group (n=200) groups and control group (n=200). The investigator rated the pain by using visual pain analog scale. Results: Sixty Nine percent (n=137) of cases in aroma massage group expressed it was helpful, provided pain relief and emotional wellbeing during labour. Our findings suggested, aromatherapy was helpful in reduction of duration of labour (p<0.0001). Biofeedback is also an effective in reducing pain and duration of labour during childbirth compared with the non-experimental group. Conclusion: The results of this present study indicated that the use of Aromatherapy and Biofeedback were both effective methods of reducing pain perception and duration of labour among women during labor.
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ABSTRACT Objective: Postmenopausal women usually experience symptoms related to vasomotor instability due to a decline in estradiol levels. Certain plants have been found to have components that are same in structure and function to female estrogen and progesterone. This study conducted to compare the efficacy of Vitex agnus-castus (Vitex) with placebo in postmenopausal women with hot flashes. Design: Sixty postmenopausal teachers with 45-60 years old participated in a clinical trial conducted in an academic center in Gorgan-Iran. The participants divided in two equal groups randomly and treated with Vitex or placebo, 40 drops per day for 8 weeks. Data collected by using interview, individual characteristics questionnaire and evaluated by Blatt-kapperman’s index at four follow-up visits. Statistical analysis was carried out by using descriptive statistics and multivariable analysis. Results: The difference in frequency of hot flushes between groups was significant at 2nd, 4th, 6th and 8th weeks of intervention (P=0.015, p=0.000, p=0.000 and p=0.000, respectively) and also the decline in the severity of hot flashes in women who received Vitex was more evident on 2nd, 4th, 6th and 8th weeks (p=0.015, p=0.12, p=0.000 and p=0.000, respectively). Furthermore, comparing both study groups the result showed that the difference in Blatt-Kupperman index was not significant on the 2nd week of treatment (p=0.198); however, it was statistically significant between the two groups on the 4th, 6th, and 8th week of treatment (p=0.008, p=0.00 and p=0.00, respectively). Some adverse events recoded between groups were statistically significant (p=0.012). Conclusion: Despite some unimportant adverse events, this study showed that Vitex as a natural therapeutic agent is an effective treatment for the early vasomotor symptoms of postmenopausal women especially in women who have a contraindication to use of female hormones but this recommendation requires to more studies with larger samples.
Article
Background: Post caesarean section pain is a common cause of pain in obstetrics, safe pain control methods after caesarean section is a greater challenge for health care providers because the spread use of drugs can cause side effects. Non-pharmacological measures are safer with fewer side effects than pharmacological measures. Aim: The aim of the current study was to evaluate the effectiveness of aromatherapy with lavender oil in relieving post caesarean incision pain. Design: A quasi-experimental design comprising two groups was used, with a sample of convenience of 100 post caesarean section mothers. The study was conducted at the postpartum unit in Suez Canal University Hospital, Ismailia City, Egypt between October 2013 and January 2014. Fifty mothers comprising the experimental group were inhaled 1 cc of lavender essential oil via an oxygen facemask and used for three minutes, while fifty participants of the control group were given placebo then the pain level was assessed after half an hour using Visual Analogue Scale (VAS) and Modified Johanson Pain-O-Meter (MJPOM). Results of the study showed that, aromatherapy with lavender oil via oxygen facemask effectively relieving post caesarian incision pain, and highly statistically significant differences in pain intensity between the groups understudy (p< 0.001) was observed. Conclusion: Lavender oil is a successful relieving pain after caesarean section. Therefore, hospital staff managers are encouraged to establish standards of aromatherapy care in maternity department and add aromatherapy concepts and techniques in the continued training program of nurses and midwives.
Article
Using non-pharmacological pain relief methods for reducing labor pain has always been one of the major concerns in obstetrics and gynecology. Comparing the effects of aromatherapy with jasmine and salvia on pain severity and labor outcome in nulliparous women. In this randomized clinical trial, 156 nulliparous women in labor were randomly selected and divided into salvia, jasmine, and control groups (52 in each group). The study duration was 6 months (from October 2009 to March 2010). Each group underwent aromatherapy using an incense mask for 15 min (distilled water for the control group). Pain severity was measured before and 30 and 60 min after the incense aromatherapy. Also, duration of the first and second stages of labor, first- and fifth-minute APGAR scores of the baby, and the frequency of labor type were measured and recorded in each group. In comparison to the other groups, pain severity and duration of the first and second stages of labor were significantly lower in the aromatherapy group of salvia 30 min after the intervention (P = 0.001). However, no significant difference was found among the three groups regarding pain severity 60 min after the aromatherapy, first- and fifth-minute APGAR scores of the baby, and the frequency of labor type. The results of the present study indicated that aromatherapy with saliva had beneficial effects on pain relief, shortened the labor stages, and had no negative impact on the baby's APGAR score.